Elacestrant (RAD1901) is an oral agent, meaning there is no need for intramuscular shots, compared with other selective endocrine receptor degraders (SERDS), such as fulvestrant (Faslodex), for use in select patients with advanced breast cancer, explains Aditya Bardia, MD, MPH.

Bardia, who is director of breast cancer research and medical oncology, and attending physician at Massachusetts General Hospital Cancer Center, as well as associate professor at Harvard Medical School, recently presented on elacestrant’s performance in the phase 3 EMERALD trial (NCT03778931) during the 2021 San Antonio Breast Cancer Symposium (SABCS).

The data revealed that elacestrant improved progression-free survival among patients with estrogen receptor–positive, HER2-negative metastatic breast cancer who previously received CDK4/6 inhibition.

®, Bardia highlighted key pieces of patient education in regard to the agent and its optimal use.

“Because it is an oral agent, I think the thing to consider is that it does cause nausea,” he said. “It can also cause upper GI discomfort. Those are important education pieces for patients.”

“If a patient is having a lot of acid-like symptoms, then the use of a proton pump inhibitor or other anti-acid medications would be very reasonable,” he added. “If a patient really has severe nausea, then the use of anti-nausea medication would be reasonable. But, overall, the drug is well tolerated.”

Bardia A. Elacestrant, an oral selective estrogen receptor degrader (SERD), vs investigator’s choice of endocrine monotherapy for ER+/HER2-advanced/metastatic breast cancer (mBC) following progression on prior endocrine and CDK4/6 inhibitor therapy: Results of EMERALD phase 3 trial. Presented at: 2021 San Antonio Breast Cancer Symposium; December 7-10, 2021; San Antonio, TX. Abstract GS2-02.

Videos

Nausea and upper GI discomfort are frequently linked with use of the oral SERD.

Oral Elacestrant Requires Patient Education in Metastatic ER+ Breast Cancer 

Aditya Bardia, MD, MPH, attending physician at Massachusetts General Hospital and assistant professor of medicine at Harvard Medical School, discusses COVID-19 (Coronavirus) risk in patients with cancer and the elderly.

We don't have the answers yet in terms of how COVID-19 will impact immunocompromised patients. We do know from what was seen in China that elderly patients were the ones who were at higher risk of having a more serious infection. One can anticipate that immunocompromised patients might also have a more severe form of infection.

Having said that, there's a lot of development that's going on in terms of developing assays to detect this disease earlier. And [there's] also a lot of work being done on vaccines. So there's a lot of work being done which could change the natural history of this disease.

COVID-19 and Cancer: Oncologist Shares His View

Physicians are looking for a way to further classify the tumors of patients with triple-negative breast cancer (TNBC), but some of the sub-classifications they have come up with are not actionable in the clinic yet, according to Adity Bardia, MD, MPH.

TNBC is difficult to classify into subgroups but finding a way to do so can help physicians narrow their treatment options, but there is not enough research to determine which treatment options should be used based on these subgroups. Bardia, attending physician of medical oncology at Massachusetts General Hospital, had the chance to speak with OncLive®, a sister publication to 

 Chemotherapy Foundation Symposium, hosted by PER®, on why these classifications do not have an impact in the clinic yet.

The majority of triple-negative breast cancers are basal, but you can also have tumors that are luminal A or luminal B. They're have also been attempts to subclassify even this basal subgroup into BL1 or BL2, but the important question to consider is, is it actionable? If I were to classify triple-negative breast cancer based on say FAM50, luminal A plus basal, does it have an impact on my clinical decision making?

And at this time, we don't have that evidence, and that's why this classification is not used in the clinic. The ER-positive, HER2-positive and triple-negative breast cancer classification is used in the clinic because it's actionable. If a tumor is ER-positive you can use endocrine therapy, if it's HER2-positive you can use anti-HER2 therapy, and for the rest, it's either chemotherapy or a clinical trial.

While physicians are looking to further subclassify TNBC to narrow treatment options, not all of these classifications are actionable in the clinic.

Aditya Bardia, MD, MPH

Articles

Oral Elacestrant Requires Patient Education in Metastatic ER+ Breast Cancer

COVID-19 and Cancer: Oncologist Shares His View

Utilizing Actionable Classifications in TNBC